Provider Demographics
NPI:1700269933
Name:BANATTE-GARCON, ROLDINE
Entity Type:Individual
Prefix:MRS
First Name:ROLDINE
Middle Name:
Last Name:BANATTE-GARCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5251 OFFICE PARK DR
Mailing Address - Street 2:STE. 202
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0404
Mailing Address - Country:US
Mailing Address - Phone:661-829-0074
Mailing Address - Fax:661-200-7783
Practice Address - Street 1:5020 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0631
Practice Address - Country:US
Practice Address - Phone:661-324-4100
Practice Address - Fax:661-324-4600
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily